Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Wednesday, March 1, 2017

If You Have Queries About Infant Eye Contact

A number of people have brought up questions about infant eye contact on pages that are so full that no more comments can be published. It's really difficult for me to move those comments to other pages and to be sure you can see them!

If you have recently asked a question on this subject and have had no answer, please put your comment HERE on this page.

17 comments:

  1. Dear Dr. Mercer.

    I have a question about my 9 weeks old daughter. Her motor development, gaining weight, hearing is ok (checked at specialist) . She sleeps almost all night (5 hours) and she sleeps a lot during the day too (3 hours together). I notice (last two weeks) her poor interest in social interactions. She doesn't look at people (she often turns her head away), she doesn't seem interested in human contact (she doesn't seem uncomfortable when people are around, she just doesn't look at them, she likes to cuddle). When I have her on my knees I can get her attention (after some time spending on calling her, making noises, funny faces), she looks in my eyes, sometimes responds. It's the same when I change her diaper. She loves to watch her toy above the changing table (when she is concentrating on it I take it away and sometimes she looks at me afterwards and sometimes "protests" with making some sound or "light cry".) She often just stares somewhere (she's very focused). She rarely or never gaze at her father or little brother. I noticed her "special" hand movement (twisting to face, grasping), especially when she is waking up, meanwhile or after breast feeding. She has trouble with often hiccups, spitting milk (she "drinks a lot of air sometimes). I encourage her social interaction, I try to use toys like "triggers". What is your opinion? Thank you very much for your answer.
    J.

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    1. I am not sure what you are worried about, J. Are you concerned that these behaviors are signs of autism? Are you thinking that what you have described is not normal for her age, or are you saying that she used to be more social and now has stopped?

      If she was more social and has stopped, I can see why you would be concerned. But if your question is just whether she is developing in a typical way, I don't think there is anything to worry about.

      Babies usually become more sociable and reactive to other people between two and three months, but this does not mean that they change overnight. As is the case for many developmental changes, when a baby shows more social behavior for the first time, that does not mean that she suddenly socializes much more than she used to. Her social responsiveness will develop gradually and will be greater on some days and less on others. Right now, you have to work to get her social attention-- later, you won't need to do so much.

      Do you really think she protests when you take the toy away? That would be a sign of quite advanced development if she noticed the toy was gone and looked at you as the person who took it! If she is really doing that, it's a good sign that she knows you are a person, which is the foundation of social interactions.

      Babies do put their hands to their faces and often hold onto their own ears when awakening or nursing.

      Have I answered your questions, or am I misunderstanding your concerns?

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    2. Thank you very much for your quick answer. No, she wasn't more social in the past few weeks. I hope that will improve in the future. Yes, I am worried about early signs of autism or some other developmental issue (as she is not interested in other people). I'll keep on encouraging her. Today I took away the toy after she was watching it again and she looked at me immediately after it (2-3 times, but she didn't protest). When I get her attention she listens to me and looks at me (I can talk to her for 5-10 minutes), but she rarely makes sounds (she just starts opening her mouths or smiles sometimes). But again - she's showing this behavior only with me). Thank you very much!!
      J.

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    3. Opening her mouth when you talk to her is the first step in her getting ready to reply. She does not have to be interested in everybody, she just has to be interested in SOMEBODY, and it sounds as if she is really interested in you, probably because you're making the effort to work with her.

      If you continue to be very uncomfortable about this and to feel anxiety and depression about her development, it might be a good idea for you to talk to your doctor about your feelings. There is help to make you feel more comfortable-- not that motherhood is not a time of anxiety, but it doesn't have to be so bad.

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  2. Dear Dr. Mercer,
    I am writing to you as a Grandma. My daughter, her husband and their baby girl live 1000 miles away from me. Much of what I am reporting to you is hearsay from my daughter, although I have visited many times. Baby was born full term and is now 8 months old. Mother and father are both highly educated.Mother is 32, father is 37, father's brother is severely autistic. Baby had nursing issues initially, and some gastric reflux although now she nurses normally and is eating some solids. Baby sat up at 6 months, is doing the GI-Joe crawl now. Baby is always trying to pull self up and move around. Mother is worried that baby doesn't make enough eye contact and seems to be a whiny baby. Mother reads to her, takes her swimming at the Y, is a very engaging parent. Mother just can't seem to convince herself that baby is okay. Baby makes eh, eh, eh sounds but not many vowel sounds and certainly no consonant sounds. Baby will pull Daddy's glasses off, but doesn't do a lot of interacting in general. Mom thinks baby is "needy"---not a "chill/calm" baby. Maybe Mom is wound up too tight. Any advice you can give to me?
    Worried Grandma

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    1. Dear WG--is the concern that the baby will be autistic like the uncle? I think the good motor progress probably argues against that, but as I'm sure you know, it's much too early to tell.

      Do you have any idea of what the mother expects in the way of eye contact, or what she would think was enough? Of course a baby this age should look at other people's eyes sometimes, but she can't be expected to use the gaze the way older people do (to point, for example), nor will she do mutual gaze for many seconds.

      The vocalization seems a bit more problematic. I would expect her to make a lot more sounds by now, but in fact there is a lot of variability in expressive language, and it's more important that she respond to what's said to her-- her name, Mommy or Daddy, the dog's name, etc. Incidentally, I saw this lack of vocalization in one of my own grandchildren and was amazed and worried that he did not even "talk" to himself while falling asleep. He had early intervention for speech when close to two years but almost immediately progressed to speaking well and has continued good development.. so who knows!

      Without knowing any more about the family, let me just put out the possibility for you to consider that the mother's anxiety is driving some of this and can even make her sterling efforts at engagement less successful than you would expect. Do you know whether she has been screened for perinatal mood disorder? She can talk to her ob/gyn about this. She might benefit from treatment.

      It's not totally unrealistic to worry about autism when there is a near relation who is so badly affected, but the chances are very high that there's no problem-- especially because the baby is a girl.

      Just wondering-- does the baby peek-a-boo?

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  3. Hi Mercer,

    My baby boy is now exactly 3months. When we smile at him he smiles back and he coos as well he does observe our faces when speaking. all this he will be doing when he is lying on his back.
    when we hold him up or in the sitting position he wont be giving eye contact or he wont even look at the people faces. he wont even pay attention to the new people
    he will be gazing at top of the roof or celling fan or black and while picture hanging on the wall. I am concerned that these behaviors are signs of autism?
    Even raised a concern with Pediatrician she doest seems to be worried about. Am i worrying a lot??
    please do give your valuable suggestions.

    Thanks,
    Swetha

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    1. Dear Swetha-- I am not surprised that your pediatrician is not worried! There is nothing to worry about here. He sees some new and interesting things, that's all, and having a healthy curiosity he wants to look at them.

      I am going to write a new post about the eye contact issue soon, and perhaps that will help you stop worrying unnecessarily-- which is what you are doing!

      He sounds like a lot of fun, by the way!

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  4. Hi, Dr. Mercer,

    I've read through a lot of your posts relating to eye contact and autism. Not sure if you've directly talked about this but maybe you have.

    I have an 8 month old son. He has met all his motor milestones on the early side. He babbles constantly - but not conversationally back and forth. Nanana, dadadada, mamamama. But he doesn't mimic us. He doesn't clap or wave. He doesn't seem to be affected by any sensory things - loud noises or textures. Although he bear crawls on the hardwood because I think he doesn't like putting his knees down on that surface. He gets super excited when my husband or I come home from work and crawls to us. He smiles ALL THE TIME at people and our dog. And daycare and all his doctors and nurses say when does this kid not like to smile? He laughs when we tickle him and laughs when I make silly noises. He smiles when I put the burp cloth over his face and ask where's Graham? He will pull it off and smile at me. He won't do peekaboo himself. He reaches to be picked up when I reach out to him. He responds to his name when he's not super focused on a task or very tired (or chasing the dog). He loves new people and will watch them more intently than he watches me most of the time. He definitely notices when new people enter the room and start talking to him. Anyways! His eye contact has always worried me. From day 1. He makes eye contact from longer distances ranging from changing table to in his play pen looking up at you. The eye contact doesn't last long, it's like 5 seconds or glances. He doesn't stare us down - although he may do that a few times a week mostly when he's feeding himself his bottle and I'm sitting on the floor next to him. The most concerning thing is that he doesn't look at us when we are holding him. He turns his head away and won't look at our faces. He will grab my husbands glasses. I've gotten him to look at me if I make a crazy sound. It is freaking me out. A lot.

    I'm hyper sensitive to all the odd things he does. I'm a physical therapist so I'm aware of his physical milestones but less educated on normal ranges of social milestones. I am also freaked because my husband is mild undiagnosed Aspbergers. He had sensory and social issues as a kid but always met his physical milestones early - walked at 9 months for example.

    I have pretty severe PPA/PPD that I'm getting help for soon. I know I obsess over my sons behavior and I freak every time he doesn't turn when I call his name. When he turns away when I'm talking to him. When he stops babbling for a few days. I know I have issues but I just feel like something is off. I've told my husband this and he said he can understand my fears but feels like our son is fine. He also points out that I've been "sure" about other things with him that haven't come true. He has a point there. My anxiety can cloud a lot.

    Anyways, can you shed some light on what is within normal for eye contact up close and anything else I've mentioned ? It would be greatly appreciated.

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    1. Dear Steph-- I think you already know that you are bringing a lot of anxiety to the situation and you won't see it clearly until that is resolved.

      Babies normally make relatively brief eye contact rather than staring at people. That's the same as what adults do unless they are afraid of someone or wanting some positive response. Try to think of eye contact as like a gesture-- you would point at something briefly but not stand for many seconds with your finger pointing in one direction.

      As for not looking at you while in your lap, he is still farsighted compared to an adult and may be too close to get a clear image of your face. But also, he's with you-- he doesn't have to look for you, so he finds something interesting to look at. Those advertisements you see with baby gazing lovingly into Mom's eyes are just advertisements, you know. That's not a frequent event in real life.

      I understand your concerns, but really it all sounds fine to me. Just be sure you follow up on some help for your anxiety!

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  5. SANDEEP PATEL-- I can't answer your query on the page you sent it to because the page is already too full. I agree with you that your baby's apparent problems with vision and hearing need to be looked into. Passing a hearing screen at birth does not necessarily mean that there will be no further hearing problems. Can you take the baby to a teaching hospital for examination? I think it would be wise to do that.

    Good luck to your family!

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  6. Dear Dr. Mercer,
    Dear Dr. Mercer,
    I contacted you a before and found your answers very helpful. Now I have, as most parents here, worries that my 22 months old son is somewhere on the spectrum of the autistic disorders. I did sign him up for an examination and there is a possibility of an early intervention where I live. But I would really appreciate your thoughts on my worries.
    I will post this in several comments as it seems to be too long for one.

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  7. I will try to summarize it in points.
    1. My husband - my son’s father was diagnosed with an ASD as a child. Today, he would probably fall into the category of “Asperger´s syndrome” although he is currently not getting any psychiatric help (and doesn´t need it). But he has been struggling a lot during his life.
    2. Our son was a full term baby and apart from difficulties nursing in very young age he was developing rather typically. He met all his milestones normally. There were two things that made him “difficult”. First, he has always required physical contact most of the time. He could never be put down as a baby and until he was about 10 months old he only napped when I carried him and walked with him. Eventually, he would also nap when I sat down with him, and at about 10 months, I was able to put him to bed after he fell asleep. Second, as a baby he was very easy to overstimulate. I suspect that is the reason why he wanted to be carried so much, as this helped him to calm down. He wasn´t specially sensitive to any particular kind of stimulation, but he extremely easily started having these quick movements that babies have once they are overstimulated, he would become fussy, as though angry. This fluctuated, there were periods when it was worse and then better. Eventually when he was about 10 months old, these things got better. Other than that, he was a rather happy baby and also fairly open and friendly. I remember at about 10-15 months, he would “initiate” contact with strangers in the streets, smiling at them and babbling.

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  8. 3. The first thing that worried me was the language delay. He only said his first word when he was about 18 months old. Moreover, he didn´t seem to understand us and he did not react to his name. Until today, he doesn´t call me “mama” although if my husband asks “where is mama” he looks at me. We are a bilingual family and we lived in a third country, so I hoped this issue was caused by him being exposed to many languages. At about 18 months he started understanding more, for example when I asked “Where is daddy” he went to his dad. As for now, he definitely understands a lot in both languages we speak at home, but he very often does not react. For example, if we are both in the room and I call his name, he hardly ever reacts, but if I say something more relevant to him (“Do you want food?”) he immediately turns. So he definitely hears me but it seems like he decides not to answer. If I come home and shout his name, he usually acknowledges me. But we just recently met his cousin who is only 2 months older than our son and I realized the level of communication with our son is much lower. It is, for example, very difficult to walk with him on the street, as he just goes wherever he wants and does not listen to us calling him. He also does not say or nods for yes, he does turn his head for no. As for now, he speaks words, but he doesn´t speak much for communication. If I ask “Where is doggie”, he does point at a dog in a book, or if we see a dog on the street, he does say “doggie”, but if he wants to eat, he just grabs my hand and leads me to fridge, although he does know the word for food. He likes saying words and often says some words over, but he doesn´t use them much for communicating, he communicates with leading us to where he needs us or putting our hand on whatever he wants. He also has an unusual intonation for some words, but I have to say his father does the same and possibly this is learned. I am not sure. He babbles a lot. Recently, he started repeating word A LOT. Sometimes he repeats very well everything we say. But if I ask him a question he understands (“Where is your nose?”) he does reply to the question correctly (points to his nose). Maybe the repeating is just his increased interest in language now? He also likes singing. He started singing rather early (at about 14 months) and is very good at repeating melodies (better than I am). Although he does communicate so poorly in words, I often start singing a song and he picks it up and sings to the end, so he gets the communicative aspect of that.
    3. The other thing that worries me is that his temperament has changed. At about 18 months he has become much more clingy which I understand is normal as part of the separation anxiety. At about that time he started showing a very strong preference for me and my husband as opposed to other people. He got very upset if I temporarily left him with a stranger (even to go to bathroom, he has never spent longer stretches of time with someone else), and calmed down immediately after I came back. But not only this, he has lost interest in other people. He needs VERY long time to even acknowledge presence of others. This is a huge change from what he used to be a year ago. Recently, we spent a month with my husband´s family in the USA, and the first week our son would not even notice other people than us. After about a week he started communicating more and even played with his cousins or searched for them in the morning. Once this happened, he obviously liked spending time with them, he even, for example, kissed his cousin spontaneously, but the amount of time he needs to get to that stage is remarkably long. Even then, he is less social than most kids. Interestingly, he really likes playgrounds, he loves climbing on play structures and going down the slides, and there he seems to have no problems interacting with kids.

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  9. 4. Since this change in his behavior he also has had much less eye contact. He doesn´t look at me when I feed him (although he often eats by himself now), he often averts his eyes. On the positive side, he is able to play peekaboo, which makes him very happy, or sometimes he “hides” from me and finds it very funny when I “find him”, then he also looks at me and laughs. I have read in some on-line questionnaire that it´s ok if a toddler makes eye contact 5 times a day which he definitely does. But it´s still remarkable how often he avoids it. He also hates taking photos and as soon as I point the phone at him he gets annoyed and leaves.
    5. He does understand pointing (when I say “Look there!” and point, he turns his head and acknowledges whatever I am point at). He does point with one finger himself but he started doing that rather late (at about 14 months). He is still very cuddly and requires a lot of physical contact, with his parents he initiates body contact, comes for a cuddle, wants to be cuddles while falling asleep etc. Actually compared to other children, he still seems to want more body contact than other kids.
    6. He doesn´t have any serious tantrums. Of course at 22 months he does get angry and he definitely has been showing defiant behavior, but he usually can be calmed down and his attention distracted by something else.
    7. He does mimic our behavior and that of other children. That is very obvious. He learned a lot from his cousins during our visit, and I am sometimes really surprised what he repeats from my behavior although I never attempt to teach him that.
    8. As for pretend play, I am not sure what he should be doing at this age. He does “drink from an empty cup” but I am not sure he is really “pretending” or just checking whether there actually is something in the cup. He loves playing with cars and he often takes another object and “pretends” it´s car. Generally, he is rather obsessed with cars and trains, although his speaking is so poor, he can distinguish most common car brands and say their names. But he also likes animals, gets very excited about our bunny, feeds her and can say her name.
    I have written a lot now. As I say, I organized an assessment for him and we are waiting for an appointment. His way of speaking, his social behavior and the change he has undergone from being an extroverted baby to being a very shy toddler seem to be atypical.
    I am not exactly sure what I am asking. I would love to hear any thoughts on his behavior. Is there anything we can do to help him (other than early intervention)? He will be starting daycare two mornings a week in October after he turns 2. I am dreading it as at this very moment he seems to be so extremely attached to us. Do you think day care is a good idea?
    I am incredibly thankful for your willingness to answer these questions in your spare time. I am also following your blog and find it generally interesting and informative.
    Sincerely, Svetlana

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  10. Dear Svetlana-- I don't want to dismiss your concerns, but it is really not unusual for an outgoing baby to become a shy toddler. I don't think his temperament has changed, but his behavior and mood have changed in a way that is common during this period of development. It would be a lot more concerning if he remained equally outgoing and was just as eager to be with other people as with you and his father. His pretend play and other things like peek-a-boo sound perfectly developmentally appropriate.

    It does sound as if his expressive language is slightly delayed, and my bet is that if the assessment leads to early intervention for speech, you will see some quick changes in his language use.

    Can you stay at the day care center at the beginning and help him get used to it? Whatever you do, don;t sneak out when he isn't looking! If it's a good center, a staff member will help him say goodbye to you and will stay with him until he adjusts. It's difficult at this age because they have so little concept of time and limited language, but if you talk to the day care staff ahead of time they should be able to give you some ideas about helping him.

    I can imagine that you're concerned about having him in day care, and I also would expect that he will protest at first. However, he will probably be much less shy with other children than with strange adults.

    I think a good day care center can be very helpful, but I do think it's important that there be enough caregivers and that toddlers are in their own group rather than mixed with infants and older kids. Also, small groups of children work best, rather than large groups with larger numbers of caregivers.

    Best wishes to all of you for a good experience as he "goes away to school" for the first time!

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  11. Dear Dr. Mercer, many many thanks for your advice! We will try talking to the staff of the daycare to be able to follow it. Best wishes Svetlana

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